I’m going with ‘milks’, partly for simplicity and partly because it amuses me that this offends some people. Terminology aside, one thing not in question is their unstoppable rise in popularity. Ethical and environmental concerns, dairy allergies and intolerances, and health considerations are all contributing factors here. Anecdotally, I’ve also noticed that friends and family find plant-based milks an appealing option even if they have no intention of going vegan or vegetarian.

The breadth of choice out there is vast, and everyone’s taste buds are slightly different, but beyond this there are some other important considerations and tips that can help guide your choice – especially if you assume or expect plant-based milks to do exactly the same job as dairy milk.

1. Think soya for protein content

Plant based milks do not have the same nutrient profile as cow’s milk. The macro proportions vary quite significantly between each variety, but none match the protein content (approx. 3.5g/100ml) of cow’s milk. The only one that comes close on this front is soya milk (2.5-3g/100ml), so it’s the option that I recommend for most of my athlete and vegan clients for whom protein is an important consideration. Of the other major plant players, oat comes next with about 1-1.5g/100ml, whereas the protein content of almond (0.5g/100ml) and coconut (0.1g/100ml), for example, is negligible.

2. Sweetened or unsweetened?

Most brands come with sweetened or unsweetened varieties. Of course, personal taste preference plays a role here, but beyond that, my recommendation would be based on what type of client you are and when you’ll be having the milk. If you’re a runner or cyclist that struggles to meet the high carbohydrate demands of your training, then the sweetened option can be sensible, especially if you’ll be drinking it during key training windows. However, in the general population, we over-consume sugar, so I would generally recommend the unsweetened option if you find this palatable (I much prefer it).

3. Don’t go organic (but do shake)

This is an important one. Despite the health halo surrounding the organic label, there are times when it is best ignored. Organic foods in the UK cannot be fortified with vitamins and minerals unless such fortification is a legal requirement in that product (which does not apply to plant milks). The vast majority of non-organic plant milks do now contain added vitamins and minerals, making them an incredibly useful source of these micronutrients, especially for those on stricter plant-based diets where risk of deficiencies is much higher and good quality food sources are harder to find. Calcium, vitamin D and vitamin B12 are the most common fortification examples, but the list, helpfully, is starting to grow.

Sub-tip: make sure you always shake the carton before use, as the added ingredients (especially calcium) can otherwise settle at the bottom.

4. Look for iodine

The above tip on fortification brings me neatly on to iodine. Iodine is essential for thyroid hormone production and foetal brain development, but deficiency is common, especially in strict plant-based diets, since dairy and seafood are the most reliable dietary sources. Good plant-based sources are harder to find, with the notable exception of seaweed. However, the iodine content of seaweed varies massively and can also be excessive and lead to toxicity issues. Fortified foods therefore play a key role, and plant-based milks are just starting to recognise this and lead the way. Look for ‘potassium iodate’ or ‘potassium iodide’ on the label.

5. Not all plant-based milks are created (environmentally) equal

The dairy industry is an environmental nightmare, so any switch from cow’s milk to plant-based milk is going to be helpful on this front. However, as with all ethical debates, there are plenty of nuances that should be considered, especially if climate change and the environment in general are your main drivers for steering clear of dairy.

The three key components are greenhouse gas (GHG) emissions, water use, and land use. At a global level, cow’s milk is 3-4 times worse than each of the major plant options for GHG emissions, and 10-20 times worse than plant milks for land use. For water use, there’s much more variability within the plant milk sector, with almond and rice milks requiring 5-10 times the amount of water of oat or soya milk production (but still only half as much as cow’s milk). These are global averages, and numbers will vary from country to country (and climate to climate). Cow’s milk production in the UK, for example, is heavily reliant on rainwater and therefore water use is not a major factor. There are other considerations that I won’t even scratch the surface of here, but if this issue is as important for you as it is for me, do your research!

6. Practical issues and the curdling conundrum

Plant-based milks have some massive practical advantages – not least the fact they can be stored at room temperature before being opened, and keep for far longer than cow’s milk in the fridge after opening.

However…the elephant in the room is the curdling conundrum. Anyone who’s dabbled with plant milks will have experienced this when adding to teas, and especially to coffees. I find it weirdly unpredictable and therefore it often catches me off guard. It doesn’t affect the flavour of the drink, but it’s not nice to look at. I’ve tried doing my research, and it seems it’s a combination of heat and acidity that causes the curdling. There are a few tactics out there such as heating the milk, and / or adding it to the cup first before slowly adding the coffee, but to be honest, the only thing I’ve found consistently reliable on this front is choosing one of the ‘barista’ varieties. If anyone has any tips that I’m missing, though, please let me know!

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If this pandemic has taught us one thing, it is hopefully that we should never take our environment, wildlife, or health for granted. OK, so those are three things really, but nevertheless, they are also the three main reasons that people choose to go plant-based. And unlike Dry January, which, although important, only serves a purpose if it achieves a long-term change in behaviour and an improved relationship with alcohol, the benefits from Veganuary are instant. So even if you do only stick with it for a month, every single meal you eat that does not contain meat or dairy has almost certainly helped the environment and the fight against climate change.

If you’ve read my blogs before, you’ll know that I’m not militant about levels of restriction. In my opinion, every step in the direction of plant-based eating should be encouraged. But, if you are committing to being fully vegan, in January or beyond, you have my absolute respect and admiration.

However, there so many common pitfalls or myths about plant-based approaches that I see among clients, friends and family (and on social media…) and perhaps chief among them is that it is automatically a healthy approach. This is most certainly not the case. Whatever your definition of healthy might be, plant-based diets can very easily be lacking in multiple essential nutrients unless due care is taken. But nothing worth having ever comes easy, and personally, I find it incredibly satisfying working with plant-based clients to overcome these deficiencies. Since veganism is usually driven by strong ethics, hopefully this doesn’t put people off.

I could write a blog about each and every at-risk nutrient (and probably will do at some point), but I thought I’d just use today’s blog to re-introduce the topic, and also mention a few other useful articles that I’ve come across in the past few days.

Firstly, this piece for My Nutriweb on how to be ‘vegan savvy’ is a useful starting point. It discusses the rise in popularity, as well as this idea of a false ‘health halo’ around poorly-balanced vegan diets. It also mentions a few of the at-risk nutrients requiring specific attention, and introduces Azmina Govindji’s concept of ‘nutrient bridges’ as a means to make a vegan diet more ‘savvy’.

Then moving briefly onto sports (sorry, couldn’t resist), I loved this very practical and applied case study of a Gaelic footballer pursuing a vegan diet for ethical reasons. The paper recognises the increased interest in plant-based diets in sport, for health and potentially also performance, but also acknowledges the serious planning this requires, especially at this elite level. Indeed, this athlete’s calcium, iodine, vitamin D and B12 levels were all around his lower limits without supplementation, but there was no compromise in terms of his elite level of body composition or performance. And interestingly, his ethical dedication to veganism seemed to rub off on his teammates. A useful lesson in the power of positive role modelling.

And last but not least is this observational study of the diets of vegan runners. 30 recreational runners – all members of the Vegan Runners Club – had the adequacy of their diets assessed through comparison against recommended levels. The key finding was significant energy deficiency; 80% of athletes had energy intakes insufficient to meet their metabolic needs, and this is certainly something that rings true in many of my clients, due to the naturally high fibre and often low calorie nature of a vegan diet. Besides the impact on health (which is too big a topic to discuss here), this energy deficiency will reduce athletic performance and muscular adaptation from training.

The vegan athletes’ diets were also deficient in protein, vitamin D and selenium, although perhaps surprisingly, adequate for iron, zinc, B12 and calcium – thanks in part to supplementation.

If you were planning to start your plant-based journey in 2021, I sincerely hope that the latest lockdown hasn’t dampened your enthusiasm for doing so. It is one of, if not the most powerful thing you can do as an individual to help the planet. But I also hope that you do it sensibly and with great care and attention. I love working with plant-based clients (whether sporting or otherwise), so please get in touch if you’d like a helping hand!

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July and August

The second half of the year started in a similar fashion to June – just enjoying being in good shape and the very gradual easing of lockdown restrictions and return to some semblance of normality across the UK. This included our ‘Last Man Stands’ cricket season belatedly getting underway, albeit with lots of hand gel, elbow bump wicket celebrations and socially distanced team photos. I developed and delivered ‘introduction to running nutrition’ webinars to local running clubs and had a great response.

We were also able to escape London and get a proper change of scenery for the first time in four months, and my main running highlights of these months were an 18km hard run following Holly on her bike through rural Somerset, and the hilliest run of my life (Strava confirms this: 506m elevation gain) along the Welsh coast, from Tenby to Laugharne. At this stage of the year, 3:50 / km pace felt like a ‘steady’ effort, whereas 3:35 had become my standard tempo pace on the 9km run to work. 2000km for 2020 was chalked up well ahead of schedule, and I was undoubtedly in the running form of my life…if only I’d had a big race to prove it.

September

The month started well, with the closest thing to a race to look forward to in over six months. The Heathside handicap 5km was a safely spaced and well-planned event on the 12^th, and my 16:32 (N.B. the course was short at 4.7km) was good enough for 4^th out of 70-odd club runners.

However, it soon started to unravel. Rather than just take the tube like a normal person, I made the dumb decision to run 22km at 4 min/km pace to deep South London immediately before a full day of keeping wicket in the baking sun for my cricket team (which basically involves leaping around and landing in awkward positions). It could be coincidence, but shortly after that day I started feeling an unusual ache in my hip.

I should then have bailed on our fake club Tuesday intervals slot, but my running ego got in the way and I did the session. Later that week it was pretty obvious I’d been an idiot and overdone it. Again, at this point I could and should have listened to my body and given myself a week or two off, but had committed months ago to a long Bath to Bristol run with a couple of old school friends, also carefully planned around a very rare chance in 2020 to see my dad and granny (outside, obviously). I decided to chance it under the proviso that we kept the pace very easy and chatty. We did, and I survived, somehow, without any pain.

October and November

However, a few days later, it was glaringly obvious that this was a proper injury and I had to sort it out without any further delay. I went down the physio route, and was diagnosed with a stress reaction (the precursor to a stress fracture) and given a structured rehab plan.

So, I didn’t run for two whole weeks (I enjoyed the break more than I expected), then started with 3km at very easy pace. Every 2-3 days I ran again and increased the duration by 10%, keeping the pace very slow. Every other day I took the opportunity to do S&C (far more than I’ve ever done before), and I incorporated a fair bit of cross-training too (swimming and cycling). October saw me cover a grand total of 45km – my lowest monthly total since my running records began many years ago!

Over November, I slowly crept back up to doing my full run commute distance of 9km, and then focussed on chipping away at the pace. I had one minor setback where I veered from the plan and did a bit too much too soon, but other than that I loved sticking to the regimented, incremental structure, and by the end of November I was getting closer to 4 min/km for tempo runs and to 50km weeks.

December

Whereas November had seen slow but steady rises in COVID cases on the ICU, by December, the much anticipated second surge was here. While the numbers on the units are roughly similar to the first surge in spring, the challenges this time are undoubtedly greater, as hospitals are doing everything to keep operations and other services running alongside the direct management of the pandemic itself. On top of this, the frontline workforce is exhausted and massively depleted, with twice-weekly self-testing (a bizarre way to start the day) meaning that the self-isolation statistics are truly eye-watering.

The projections for the coming weeks are getting bleaker almost by the hour, daily death rates are nearly back to 1000, and the country is placed in ever tighter tiers of restrictions…yet the public appreciation or compliance is nothing like it was back in spring. Some are even protesting (maskless, obviously) outside the hospital chanting that it’s a hoax. If you don’t laugh, you cry.

My runs back from work this month made me angry, with people hugging and congregating on increasingly busy streets. Following a year of Government U-turns, the rules got relaxed and then tightened again for Christmas, but by this point, depressingly large numbers of the population seemed to think they didn’t really apply to them anyway. It’s fair to say that the pandemic has really brought the best out of some people and the worst out of others. As I write this, I’ve just had to quickly shave off the Christmas beard, as ICU numbers have spiralled to the extent that we now need to staff the New Year’s Day bank holiday as an emergency.

I tried to switch off from the news over my precious Christmas break, and tucked into some beautiful muddy runs around Hampstead Heath, the River Lea and Ally Pally, plus a first fake solo ‘parkrun’ for 9 months on the Finsbury Park course on Christmas morning. At 18:20, I’m nowhere near back at PB pace yet, but it’s something to build on for next year.

But perhaps the most significant run of the year was on Tuesday morning, as I jogged home from receiving my first dose of the COVID-19 vaccine: the light at the end of the tunnel that my ICU colleagues, and no doubt millions of others, will be clinging onto over the next few weeks.

The post 2020: An unforgettable year as a runner…and ICU Dietitian (part 2/2) appeared first on Tom Hollis.

Perhaps a little self-indulgent, but this year has been unforgettable for all the right and mostly wrong reasons, so here’s my month-by-month recap. I’m lucky that running is a constant in my life, and something I can turn to on even the hardest of days, so I’ve based this blog around that.

January:

Starting the year buzzing with optimism but still burdened by my terrible sense of direction, I got lost and missed the start of Whitstable parkrun, but caught up from the back and swore this year was definitely going to be the year I got to my first milestone of 50 parkruns. Nothing was going to get in the way of that…

As part of that burst of parkrun positivity, I finally volunteered at one too (the 500^th at Finsbury Park), and then sneaked a new PB by one second at Burgess Park (17.55).

And this was also the year that I was going to become a better and stronger all-round runner. I showed up for my first proper XC race at Ally Pally in ludicrously muddy conditions. It quickly became apparent that I was the only runner not wearing XC spikes, and I basically slid my way round the hilly course, but I loved it (and promptly purchased some second hand spikes).

Finally, knowing that this is where the PBs are built, I headed back to track Tuesdays with London Heathside and vowed not to miss a single session without good reason this year. Again, surely nothing would stop that…

February:

Some mad storms (Ciara and Dennis, respectively) blew in, so I took to the gym and the treadmill to keep up the workout intensity prior to race season.

I was also doing hill reps at least once per week, did my favourite ‘1 hour gas test’ run to gauge where I am with training (15.78km), and got somewhat obsessed with dietary nitrates, as I went all-in on a literature review as part of my Sports Nutrition Postgrad.

March:

A month of utter madness couldn’t have started better. On the 1^st of March, I took on the Big Half in London and I think it was probably the best racing performance of my life to date. I smashed my PB by well over 2 minutes (1:17:15), and it’s the first time I’ve finished a race with a time I didn’t know I was capable of (and I wasn’t even wearing carbon plated shoes!)

A week after that I took 20 seconds off my parkrun PB (17:35) at the hilly course at Finsbury, then the following Saturday I took a further 6 seconds off that (17:29) and notched up my first ever 1^st place finish at my home town course in Frome. Little did I know then that that would be the last parkrun of the year, and that nearly 10 months later I’ve still been unable to defend my ‘title’.

Meanwhile of course, things were getting really scary in the news, and at work on the ICU. Our unit was starting to fill up with COVID positive patients, and it became apparent that this was the start of a serious pandemic. Nonetheless, Bath Half Marathon refused to cancel on the 15^th or even offer me a refund if I didn’t turn up, despite me explaining why I couldn’t possibly do so given my work. I’d run this race 7 or 8 times previously, but won’t be signing up again.

A week later, the country was in full lockdown. Work got crazier and crazier and life became restricted in so many ways, but one tiny silver lining was my daily run commute home. Over the next few weeks, I felt like I had the wide streets and landmarks of central London to myself, and the sun shone every single day. Truly unforgettable, surreal scenes.

April

I grew an FFP3-ready moustache (i.e. medical grade face mask), initially as a bit of a joke, but 8 months later it’s just become my permanent 2020 look (albeit accompanied by a temporary Christmas beard as I write this). It was either that or full on clean shaven…no thanks.

Early in the month, I attempted but couldn’t sustain a decent pace for what would end up being my longest run of the year (28km). I started to realise that the stress and emotion of work was taking its toll and that I shouldn’t take it or my physical or mental health for granted. It became impossible to switch off from the news, especially as it made its way closer and closer to home. It’s no secret that the Prime Minister himself was on our ICU, and the hospital site was awash with media and security. It was intense.

So, I slowed 90% of my runs right down and switched others out for glorious walks through beautiful North London residential streets with Holly, and just used it as my time to try to switch off and zone out. It helped, to an extent, and I then allowed myself to really let loose once per week for a 5km time trial at the weekend. I definitely don’t regard these as official PBs, but took great satisfaction in building up to them as if they were races, and managed 17:15, 16:54 and 17:07 in consecutive weeks.

May

I managed to get my 6^th and final piece of sports nutrition coursework in on time, just. This was a mammoth ‘Sportfolio’ case study with an athlete that had proved to be a useful distraction from the day job, but I could not have been happier when I pressed ‘submit’. The feedback a week or two later was the best I’ve ever received across my whole academic life, and it just confirmed how much I love working in sports nutrition. Since then I’ve officially launched Tom Hollis Performance Nutrition, and have enjoyed every second helping like-minded endurance athletes and plant-based clients reach their potential.

Other than that, May was really just a month to keep things ticking over. The ICU was still unrecognisable in size and appearance as we tried to treat the huge number of COVID patients (many of them long-stayers at this stage), and at least a dozen redeployed dietitians were still part of our now sizeable ICU dietetic team. We kept up team morale with daily 5 minute exercises (obviously I loved this) and weekly international shared lunches on Fridays (a rare chance for people to use their creativity in an otherwise boring year), and I used those Friday mornings to blitz a tempo run to work to make the most of the ensuing onslaught of global carbs.

The weather remained beautiful throughout May, and I kept the pace low but the mileage up. I passed 1000km for 2020 early in the month, and pretty much every evening I ran (slowly) to the park to hang out with Holly and Harvey (our part-time dog). It wasn’t all bad.

June

The Black Lives Matter movement was in full swing, and at least twice I got caught up in BLM protests as I stupidly planned to jog home through Whitehall. Things finally started to calm down on ICU though, at least in terms of COVID. The temperature also started to drop, so I decided to use this as my opportunity to ramp things up again with my running; I got back to regular tempo runs, some rare double run commutes, solo interval sessions on the track, and hill reps at least once a week.

With the Sports Nutrition Postgrad successfully completed, I now had some free time at the weekends, and needed a new routine. I started doing much-missed Sunday long(ish) runs again, finishing up at Starbucks for my free NHS coffee and Aldi in time for the NHS only opening hours. For once in our careers, my colleagues and I were made to feel pretty special and appreciated in those weeks, and the cherry on top for me was a free pair of Brooks Glycerin 17s that arrived through my door. They’ve been my comfy run commute go-to shoe ever since.

As for those long runs, I found myself in surprisingly good shape, and despite keeping things controlled and steady, notched up the following:

7^th: 21.1km at 3:53/km pace

14^th: 22.1km at 3:56

21^st: 18.5km at 3:56

27^th: 21.1km at 3:55

It was around this time that Tuesday club sessions restarted on the track, but due to distancing and time restrictions, I joined a little group of Heathsiders in doing our own replica sessions instead. It felt great running with others of the same level for the first time in months, and also made me realise that all that consistent run commuting (slow or otherwise) had added up to leave me fitter than I’d ever been.

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I’m happy to report that this drift has continued, and I managed to avoid eating meat for the whole of 2018. Well OK, that is not entirely true, as I had one mishap on the flight back from my own stag do in Porto, when I ate a bread roll with chicken puree which I thought was hummous. Hard to believe that my abstinence was broken, not for a juicy burger or Sunday roast, but a distinctly average airline snack. So anyway, I’ve chosen to overlook that one setback and continue working towards (and thoroughly enjoying) a fully plant based diet. As is tradition, the aforementioned stag do was closely followed by my wedding, and we kept it meat-free there too (see pic above). This was certainly met with a bit of scepticism in the build up, but we made sure that it was vegetarian (and mostly vegan) food done properly – in other words, beautiful to look at, but even more of a delight to eat. The feedback we had from our guests was almost exclusively really positive (you can never please everyone!)

Media coverage of vegan / vegetarian / plant based eating really is everywhere right now, and I genuinely can’t see it disappearing any time soon. The recent  EAT-Lancet report attracted plenty of coverage (and as ever in modern Britain, furious ‘debate’ too). This report was the result of a scientific review process to define a healthy, sustainable diet to support the planet and its growing human population in decades to come. Inevitably, the report recommends huge reductions in meat intake (a tiny 14g of red meat per day, for example), as well as tight restrictions on dairy too.

The report ruffled plenty of feathers and made many people uncomfortable, but the facts are getting harder to ignore with every passing month. Personally, I’m now at a stage where most meals are vegan, but I still eat the occasional portion of sardines or other oily fish, very small amounts of butter and cheese, and eggs that are from truly free-range sources…like the hens in my parents’ garden! I’m still very much of the opinion that the message of plant based eating needs to be spread positively rather than with angry or smug judgement, and that it is absolutely fine for anyone to make slow and steady steps towards achieving it.

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Q2. What about protein?

Protein remains all the rage, and people often worry that a plant based diet might waste away their sculpted muscles, leaving them a weak imitation of their former self. The media is to blame here –  it continues to purvey the myth that protein is endlessly desirable; that more is always better; and that it is a nutritional panacea, removing hunger and giving us all wonderful physiques. With meat and meat products being comfortably the biggest contributors to UK protein intakes (37%) and dairy the third biggest (14%), it’s easy to see how concerns about protein might arise if faced with the prospect of removing animal products from our diet…especially in the context of our misleading media.

But the reality isn’t as dramatic as that. Yes, protein is essential, for growth and repair among other things, but in general we massively overeat it in this country. We have a finite capacity to use the protein that we eat, and any leftover building blocks (amino acids) are split, with the nitrogen containing part converted to urea and flushed down the toilet, and the other half stored – not as muscle, but as fat.

And yes, protein requirements do vary somewhat with life stage and lifestyle, but the general reference nutrient intake (RNI) for protein in 19-50 year olds, for example, is 0.75g / kg body weight / day (roughly 56g per day for a ‘typical’ 75kg man). Bear in mind, then, that the average UK man eats 88g of protein / day, and it’s clear there’s plenty of room to play with.

I am not going to pretend that protein intakes come effortlessly with a plant based diet, but as ever, it just requires a little more thought into meal preparation, at least initially. The key is getting to know and love some good plant protein sources, and including one or two of them at every meal. Some of the classics (and among my favourites) are beans, pulses and grains (e.g. lentils, chickpeas, quinoa), as well as tofu, nuts and seeds. These are therefore all key features of the vegan diet, but even certain cereals and vegetables can be a surprising boost to protein intakes (e.g. rice, broccoli, spinach and kale). An added advantage of most of these plant-based protein sources is that unlike many of their animal equivalents, they are high in fibre and low in salt and saturated fat.

3. Any other nutrients I need to worry about?

Yes, without doubt. A vegan diet will usually be incredibly rich in many vitamins and minerals without even trying, but others will run the risk of deficiency.

Vitamin B12 is essential for our brain and nervous system, as well as red blood cell formation, but unfortunately is abundant in animal foods but scarce in plant foods (besides fortified products).

Calcium, crucial for bone and teeth health and nerve transmission, can be found in vegan foods such as almonds, dried fruit, kale and fortified dairy alternatives, but we all have high calcium requirements, and it’s undoubtedly harder to meet these targets once dairy is out of the equation.

Iron is vital for its oxygen carrying role in our red blood cells, but it’s another one of those nutrients that’s more concentrated (and better absorbed) from its animal sources than plants. That said, it is still available in a wide range of plant foods (e.g. lentils, nuts, seeds and fortified breakfast cereals), so it’s just a case of identifying and prioritising these.

The final nutrients that warrant a mention here are omega-3 fatty acids. Alpha linoleic acid (ALA) is considered ‘essential’ in the diet, because we can’t make it ourselves, although we are able to (albeit inefficiently) convert it to the very useful long-chain omega-3 fatty acids, known as EPA and DHA. EPA and DHA continue to be widely researched, and while we probably don’t yet know the full extent of their physiological roles, there is some consensus that they can reduce inflammation,  which is likely to play a part in their postulated roles in cardiovascular and mental health. Annoyingly, EPA and DHA are not found in many foods, and without oily fish in the diet (mackerel, salmon, sardines etc.), it can be difficult getting enough, which is why government guidance remains for us to eat one portion of oily fish per week. However, the fish don’t actually make their own omega-3s; rather they obtain them from the microalgae in their own diets. So, vegans have the option to cut out the middle man here and supplement their diets with microalgae. Additionally, vegans should be looking to ensure that their diets have plenty of ALA (which, if you remember, can be inefficiently converted to EPA and DHA), such as linseeds or chia seeds.

The bottom line here is that a vegan diet, although generally very nutrient dense, can also leave some gaping holes. These can be somewhat addressed by carefully considered dietary modifications, but I would also recommend a multi-vitamin and mineral supplement that helps fill the gaps. Of course it is better to obtain all nutrients from food rather than pills wherever possible, but I just feel this approach helps remove some of the worry. Unsurprisingly there are now vegan specialist supplements that focus on problem nutrients for a plant based diet. Unlike standard supplements, these would make sure, for example, that the vitamin D was not derived from sheep’s wool, or omega-3s from fish oils, but this level of strictness may or may not be necessary, depending on the individual.

4. What if you only eat good quality meat?

As I mentioned in the first part of this blog, people adopt plant based diets for a number of reasons, with animal welfare and environmental sustainability the most common. So the argument about only eating good quality meat is a very valid one – ‘good quality’ can usually be at least loosely associated with better farming conditions and perhaps (but certainly not always) a better standard of living for the animal. Ultimately though, the animal is still being raised and killed for human consumption, so it depends where your own ethical line is here.

Similarly, if we all just ate good quality meat in much smaller  quantities, then I feel that the sustainability argument would be hugely diluted too. My own opinion is that this is the ideal scenario – where good quality meat and fish is seen as a real treat, to be eaten on special occasions and enjoyed. If everyone had this approach, the future of our planet would instantly be far brighter. The problem is, this is never going to happen, or at least not any time soon. For most people in Britain, hardly a meal, let alone a day, goes past without meat, and this is nothing compared to the likes of the USA. And then the huge, rapidly developing nations of India and China need to be factored in, going through their economic and nutrition transitions simultaneously: a typical trend of increasing wealth and urbanisation linked to a dietary shift from plants to animals, much of it poor quality, processed convenience food. 

Given that a third of the world’s population lives in these two countries alone, I don’t feel that we have the luxury of waiting until everyone adopts the ideal pattern of eating. Instead, I think it has reached the stage where people who are sufficiently motivated need to take one for the team by making serious sacrifices. That said, I don’t think there are rules about how one adopts a plant based diet. Rushing from all to nothing isn’t likely to go well, so I would say it’s perfectly acceptable and natural to do it in stages…but then I would say that, as that’s exactly what I’m doing right now.

5. How do you live without bacon / burgers / cheese etc. etc. etc?

This is definitely something I used to ask vegetarians! Of course, that’s now been flipped and people are asking me those same questions. Unlike some plant eaters, I am not going to pretend that meat is suddenly not delicious. I spent 30+ years of my life eating and loving it, and my tastebuds have certainly not changed overnight. But it’s really not that difficult to live without certain foods. Turning down sizzling countryside bacon and Easter lamb with my family a couple of weeks ago was a challenge, but also a bit of a milestone for me. I think up until that point I’d thought that I would revert back to the ‘good quality meat as a treat’ option at some point, but I don’t think I will now.

If you feel passionately about anything, then you happily make sacrifices for that passion, be that your family, your hobbies, or your diet. Of course, as I have said before, your diet is something to be cherished and enjoyed; it is one of life’s great pleasures and not just a means of getting nutrients. But there’s a lot of enjoyment to be gained from becoming a better, more imaginative cook, while improving your health and the sustainability of the planet at the same time.

The post Veganism and the plant based revolution (part II) appeared first on Tom Hollis.

A: Don’t worry – they’ll tell you

There’s something about vegans that really gets under other people’s skin. They find themselves the butt of jokes for being smug / puny / dull / joyless / awkward / sanctimonious etc etc…and to be perfectly honest, I’ve had times when I’ve thought the same. I used to be more than a little sceptical of veganism (and vegans), thinking it an unnecessarily restrictive lifestyle, and the preserve of preachy individuals who wear shoes made from hemp.

No-one likes being told what to eat (or what not to eat), and we fear change, especially when it comes to something as important as food. Nor do we enjoy having our opinions challenged by uncomfortable truths, so add all of this together, and you get a little hostility.

But vegans have a delicate balancing act to manage. On the one hand, they don’t want to be the stereotype from my punchline at the top (that talks about nothing else), but on the other, they believe in this passionately enough to have made significant sacrifices, so why shouldn’t they share their views, and dispel some myths when, no doubt, challenged? After all, they are just making an ethical choice and a positive difference to animals, the environment, or both.

And like it or not, it’s not going to disappear any time soon. There might be plenty of ‘Veganuarians’ who’ve had their fill of tofu and quietly returned to juicy burgers and bacon butties, but in general, veganism and plant based eating is going to continue to flourish. And rightly so.

Veganism is still too extreme for me, but my own diet has become increasingly plant based over the past year or two, so I’d rule nothing out in the future. My shift started with an enforced meat-free month of volunteering on an eco-construction project in Uruguay (oh god, I’m starting to sound like I wear shoes made from hemp too). I was apprehensive about the prospect, but meals were easy, varied, and delicious, thanks in no small part to a French vegan couple who were resourceful and imaginative cooks. I felt fantastic that month, although of course, my circumstances probably played a huge part too (manual outdoor work in the sun all morning, swimming in the sea every afternoon…), so I won’t fall into the lazy trap of assuming causation.

I returned home to a girlfriend (now my fiancee) who had independently become more impassioned in her vegetarian views and who now is 99.9% vegan (if there is such a thing). I’m not even close to this level – in fact I’m not even a vegetarian as I still eat fish occasionally – but I’m proud to be taking steps in what I feel is the right direction. I am a huge animal lover, and I love the fact that a plant based diet is cheap and (if done well) very nutritious. These are all pretty good reasons to make the change, but for me, sustainability is by far the biggest consideration, and particularly the vast differences in greenhouse gas production and water consumption between animal and plant based diets. In my head, it is a very simple message: if you care about the planet, or are in any way environmentally minded, you should be eating less animal produce and more plants…no matter how uncomfortable that makes you feel.

Whether you go full vegan or just start cutting out meat a couple of days a week, it requires extra thought and creativity in the kitchen to prevent meals becoming repetitive…but this is surely a good thing. I must admit it also helps being a dietitian, as I am aware of and can avoid common nutritional deficiencies and pitfalls of plant based diets. Indeed, as a dietitian, more and more people want to ask me about veganism and plant based diets, so I’ve started to think of the five questions I get asked most frequently (by patients, friends and family), and some useful responses. I’ve just started with question one, below, and will follow up with the other four in a few days.

1. Is a vegan diet good for you?

The easy (and probably quite disappointing) answer here would be to say ‘it depends’, which of course it does. It depends on what sort of vegan diet you have; it depends on what you mean by ‘good for you’; and it depends on any other personal considerations that might affect your requirements.

Most important of these is which type of vegan diet you eat, or plan to eat. I know a fair few vegans who are overweight, and by no means a picture of health. Equally, there are probably a billion or so healthy non-vegans around the world who have a wonderful, balanced diet, so one is not necessarily healthier than the other. ‘Vegan’ does not always equate to ‘healthy’, whether talking about the overall diet or individual foods – you could eat as much sugar, or glug down as much vegetable oil or coconut milk as you want on a vegan diet, but of course that would be a long way from ‘good for you’.

Also important is what is meant by ‘good for you’. Some people might mean ‘help me to lose weight’, others ‘nutritionally complete’, others ‘help prevent cancer’ etc. So when a dietitian is asked if a diet, or even a specific food, is good for you, it can often be a surprisingly difficult question to answer, especially when considering the final mini-point here – individual factors and requirements.

Gender, age, physical activity, health conditions and health goals are just a few of the huge number of factors that might influence someone’s nutrient requirements, and therefore whether a vegan diet might be ‘good’ for them, so it can be really hard to generalise to a population. A very simple example would be a female of menstruating age. She would have iron requirements about 70% higher than a male of the same age, and so might be at greater risk of iron deficiency with a vegan diet, since the restrictions of the diet instantly eliminate some of the richest sources of iron. Add existing anaemia into the mix, for example, and situation is exacerbated.

Having said all of this, I think the short answer is that, yes, in general, a vegan (and certainly a vegetarian) diet would be a healthier option for most people in the UK. A vegan diet is certainly not a magic wand for health, and I’d suggest choosing to adopt it for stronger, ethical reasons rather than, for example, weight loss, but it is likely to be far high in fruit, veg and pulses (and therefore fibre and many micronutrients) and obviously low in processed meat (and therefore saturated fat and salt), all of which are problem areas in the UK diets. An added bonus is the fact it encourages you to be inventive and think more carefully about food and meals – undoubtedly a key factor in the success of any diet.

So please pay me another visit in a few days, when I’ll have written up the reponses to the other four most common questions on veganism and plant based diets. See you then.

The post Veganism and the plant based revolution (part I) appeared first on Tom Hollis.

Latin America is my favourite part of the world, so when two friends asked me to join them on their trip, it was an easy decision (well, for me at least…maybe not for my employer!) We kept our plans for the trip deliberately vague, but the absurd levels of inflation here soon made it apparent that settling in the capital, Buenos Aires, long-term was not going to be financially feasible. Last time I was here, in 2009, everything was affordable, and I felt wealthy as a visiting Brit. Sadly this is no longer the case (the economic instability in the UK is nothing compared to what these poor people have to endure), so we decided to hire a car and live cheaply while seeing as much of this massive country as possible.

And after over 8000 km of this most memorable of road trips, we were consistently taken aback by the size, not only of the country itself (8th largest in the world, I believe), but of its inhabitants too. Since this is not a travel blog, i’ll skip the guanacos, glaciers and gauchos and focus instead on my nutritional interpretation of the country…

Argentinians are famously (or infamously, depending on how you see it) obsessed with image and beauty. They are not sheepish about plastic surgery, unlike us, and it is not uncommon to see men and women walking around with bandaged faces after a fresh nose-job. And indeed, my recollection of Argentinians in 2009 (particularly the ‘porteños’ of Buenos Aires) was one of style and elegance.

Again, however, I instantly noticed a change this time around. The Argentinian population, particularly in Buenos Aires but also all over the country, had gotten perceptively fatter. There’s no other way to put it. So I started looking into it, and indeed there is no shortage of articles confirming that this is a major and growing health concern in the country, that its child obesity rates are among the highest in the continent, etc etc.

It didn’t take too long to realise why this might be. The nation appears to have an extremely sweet tooth – large bottles of fizzy, sugary drinks are universally popular despite also being ludicrously expensive, and even things like instant coffee have vast amounts of sugar unnecessarily added to them. Burgers, milanesas (schnitzels) and deep pan, ultra-cheesy pizzas make up the majority of most menus, the standard ‘miga’ sandwiches use the most nutritionally unrewarding, bland white bread and ‘salads’ don’t generally extend beyond lettuce and tomato.

Argentina is famed for its steak and red wine, and while either of these could of course be detrimental to health if consumed to excess, I can’t help but feel the real damage is being done by the more day-to-day eating habits of this beautiful country.

It may well be that inflation and economics are partly responsible here. Fruit and vegetables, for example, are generally of good quality, but certainly not cheap, and essentially we’ve found it tough maintaining a healthy, balanced diet on a budget out here. Perhaps local families can’t always afford to make the healthy choices either. With this added to the fact that it’s basically too hot to exercise outside in summer (any hopes I had of beating my marathon PB this year might just have vanished), you don’t have to be a genius, or indeed a dietitian, to work out that waistlines are going to expand and health deteriorate.

It would be completely unfair not to mention that I’ve also had some of the most unforgettable culinary experiences of my life over the past few months, but in general, it has made me appreciate what we have in the UK. I would say that communication and comprehension of public health messages is far better back home than here, and I also know from my days in the food and drink industry, that communication between food companies and UK government is perhaps better than it is perceived to be. A good example would be the ‘Responsibility Deal’ which sees companies signing up to reformulate their products to help achieve government nutrition targets.

So, with my return to London looming large as I write this, I know I’m going to miss a lot that Argentina has to offer, but I also can’t wait to walk into a reasonably priced supermarket fruit and veg aisle or to see some variation in restaurant menus – we don’t know how lucky we are!

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1.  Long follow-up times

The effects of dietary approaches are not going to be seen overnight. Instead, impacts on health might take years, or more likely, decades (which is why it is the habits of a lifetime that matter, not those of a month after Christmas). This means that studies have to be hugely ambitious from the outset, taking into account the ‘loss to follow-up’ (losing participants as the study progresses).

2.  Adherence

It’s all well and good asking study participants to follow a particular diet for the purposes of a study, but monitoring how well they actually do this is nigh on impossible. Study subjects are human, and we all know how hard it can be to follow a diet at all times.

3.  Small effects

Unlike some intervention studies that involve, for example, powerful medical treatments, the effects from dietary manipulation are usually going to be far more subtle. The problem with this is that in order for the effect to be visible and statistically significant, a huge sample size is needed – which again poses problems from the outset when designing and funding studies.

4.  Funding

Linking into some of the points above, large, ambitious studies need a lot of funding. There are of course some wonderful charities like the World Cancer Research Fund that put money and resources into relevant projects, but dietary studies are usually lacking in financial backing, unlike drug studies funded by big pharma.

5.  Disentangling

We don’t eat single foods (or indeed nutrients) in isolation. For this reason, it can often be hard to disentangle the effects of one food from the effects of others in the diet. Similarly, even though statistical methods aim to ‘match’ subjects based on exercise levels, for example, it is often difficult to eliminate the impact of other lifestyle factors beyond diet.

6.  Quality of data

Dietary data collection itself can be problematic and unreliable in studies. Methods such as food frequency questionnaires and 24 hour recalls are commonly used, but are subject to huge amounts of potential error.

These same problems do not really apply to the sharp end of clinical dietetics, for example on wards or even intensive care units, where conditions are (or should be) more easily controlled, and health outcomes closely monitored. But in the real world, we have to use a mixture of evidence, including ‘ecological’ studies (e.g. looking at Japanese / Mediterranean diets and identifying health trends in these populations).

It is because of these limitations that when in relative good health, we need to use common sense and not overly complicate nutrition – until there is sufficient evidence to support doing so. And while statistical modelling and study design techniques are becoming more sophisticated, some of the problems inherent to dietary research are likely to persist for some time.

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You don’t need me to tell you how important the heart is. Equally, I can’t imagine you need me to tell you that heart disease is, alongside cancer, the biggest cause of death and therefore the most significant of public health issues. So, it’s absolutely essential that we look after the ticker. The British Heart Foundation is really the place to go for further information, and they’ve produced some resources and 10 minute challenges etc devoted to this month of awareness, so do take a look.

Which brings me on nicely to the other thing I wanted to mention this week. The saturated fat debate refuses to die down, so I thought I really should say something about it in the blog. Perhaps you’ve seen some of the articles arising again in the past couple of weeks. As a dietitian, I’m obviously drawn to them anyway, but people also tend to send them my way to see what I make of it all.

Back in October 2013, a cardiologist by the name of Dr Aseem Malhotra questioned the validity of traditional advice to limit saturated fat intake, stating that evidence linking it with heart disease was mixed (despite then stating that a Mediterranean diet, low in saturated fat, is roughly three times as effective as taking a statin).

This received plenty of media attention then (leading to a flurry of idiotic ‘I told you so – we can eat whatever we like’ type articles), and the issue has cropped up again more recently, with contributors to the Open Heart Journal suggesting that advice to reduce saturated fat in the UK and US was based on flimsy evidence from the 1970s and 1980s, and that governments should have waited for better quality studies before reaching such important conclusions.

I must say, I have always been in the camp that reducing saturated fat intake is an important part of controlling or lowering blood cholesterol, but I am not stubborn enough to refuse to change my mind if strong enough studies come along to disprove this. Sadly, there are always likely to be limitations to collecting dietary data like this – and I plan to discuss why that is in next week’s blog.

But as I say, I am always interested in how these stories are picked up and reported by the media, and with this story, there has been the usual range of the good, the bad and the ugly.

First up, credit to this surprisingly balanced, if a little bland, piece by the BBC – read the article here.

Next was this article from Medpage, which was, again, initially balanced and informative, while also hinting at the issues surrounding clinical dietary studies. However, the article loses a bit of credibility from me by veering towards a hate campaign for carbohydrates at the end.

The worst that I have read (one of those aforementioned ‘I told you so’ pieces) was in the Evening Standard. I’m afraid I haven’t been able to find the link, but it got me hot under the collar when it placed the blame of obesity and heart disease solely on carbohydrates. Presumably this was just a hunch of his – he certainly didn’t seem to be a scientist or nutrition professional.

Which brings me on to a nice summary by Catherine Collins from the British Dietetic Association. She presents the facts well, without being biased towards her profession. The thing which I thought most worthy of mention is her point that, if we’ve learned anything from this, surely we should move on from vilifying single nutrients, and instead look at foods and diets as a whole (the Mediterranean approach, for example).

I could not agree more with this. It is laughable that people jump on the bandwagon to say all that saturated fat stuff was nonsense, but then instantly launch an attack on the new trendy enemy – carbohydrates. It’s pathetic, lazy and hypocritical.

So, this post has been a little longer than usual, but I think it’s a topic well worth looking at.

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